Melbourne School of Population and Global Health

Genital warts have all but disappeared in young heterosexual  Australians as the result of the national HPV (human papilloma virus)  vaccination program, according to research based on surveillance data from the  Melbourne Sexual Health Centre.
 
This dramatic turnaround within just four years points to  the strong likelihood that HPV-related cancers will in future also become much  rarer, according to the Melbourne School of Population and Global Health’s Professor  Christopher Fairley. Professor Fairley is Director of both the Centre and  School’s Sexual Health Unit, which is situated within the Centre.
 
“It is unprecedented for a sexually transmitted infection  that is as common as genital warts to disappear so quickly,” Professor Fairley  said. “The HPV vaccine program is pioneering for Australia and internationally  – and no country in the world has seen a reduction in warts as dramatic as  this.”

In a world first for a preventative health program targeting  sexually transmitted infections (STIs), in April 2007 Australia began  vaccinating young females aged 12 to 27 against HPV genotypes 6, 11, 16 and 18,  using Gardasil. In a paper published in the British journal, Sexually Transmitted Infections, the  study’s researchers reported that only four cases of genital warts occurred in  women aged under 21 years from 1 July 2010 to 30 June 2011, compared with up to  66 cases per year before July 2007, the year the vaccination program started.
 
Comparing two 12-month periods of 2007-2008 and 2010-2011,  the percentage of patients seen at the Melbourne Sexual Health Centre with  genital warts declined in women aged under 21 from 18.6 per cent to 1.9 per  cent. In heterosexual men aged under 21, genital warts declined from 22.9 per  cent to 2.9 per cent.
 
Factors that contributed to the study’s results included  access to very good surveillance data gathered by the centre, which saw 52,454  new patients between July 2004 and June 2011, Professor Fairley said. Australia  also introduced the vaccine before other countries and achieved high vaccine  coverage compared to other countries. “Some other countries introduced the  vaccine for school age children but Australia was different in having a  catch-up program up to age 26 in women. This meant a whole  population of women between school age and 26 were offered the vaccine free of  charge.”

Why was the vaccination program so effective? “It was well  funded, well designed, well coordinated and it had broad public appeal,” he  said. Its outstanding success had a range of significant health benefits.  “Firstly, genital warts are already becoming a rare infection in young people.  Genital warts are an unpleasant condition associated with significant  morbidity. That result is terrific for young Australians,” he said.

“Because the vaccine has other strains in it, young women  will no longer get nearly as many cervical abnormalities and so many fewer  women will need treatment for abnormal pap smears. We’ve already seen a  dramatic decline in women under 18 with high-grade abnormalities.

“Even more importantly but in the longer term, these results  suggest the cancer-causing strains of HPV – that is 16 and 18 – will be rare in  these young people. That means HPV-related cancers, including cervical cancer,  vulval cancer, anal cancer, throat cancer and penile cancer, will become much  less common over the next 20 to 30 years.”

Professor Fairley hopes to see the vaccine program extended  to young men as well, with the aim of protecting gay men from the HPV-related  cancers that affect them: anal cancer and throat cancer.

There was no chance that the vaccine’s success would dent  business at the Melbourne Sexual Health Centre. “We have many more people  coming here than we can deal with but it does mean the clinic is freed up to  treat many others in need,” he said. “It’s a tremendous efficiency gain for  sexual health services around the country.”